INTRODUCTION

Acute coronary syndrome (ACS) and end-stage renal disease (ESRD) are both prevalent globally. The diagnosis and management of ACS in ESRD is difficult because the interplay of cardiovascular and renal disease is complicated. The guidelines for ACS may not be applicable to the ESRD population because the trials from which these are drawn mostly excluded ESRD patients.

OBJECTIVE

To determine the clinical profile and outcomes of CKD patients on dialysis admitted for ACS in the Philippine General Hospital (PGH).

METHODS

We did a retrospective cohort study and employed a retrospective review of electronic medical records among ESRD patients presenting with ACS in PGH from May 2021 to November 2023. The collected data was analyzed using univariate and bivariate statistics using PRISM software.

RESULTS

A total of 48 patients with ESRD were admitted for ACS in this study – 8 with STEMI and 40 with NSTEMI. The mean age was 61 years old and 33 (68.8%) were male. Among those with STEMI, six (75%) presented with Kilip II or more. While among those with NSTEMI, 17 (42.5%) had a GRACE score >140 and 27 (67.5%) had an NSTEMI TIMI risk score >2. On average, the patients were on hemodialysis for 31 months prior to admission. The most common comorbidities were hypertension (91.7%) and heart failure (83.3%). On admission, 18 (37.5%) presented with SBP >160, 7 (14.6%) patients presented with shock, and 4 (8.3%) patients presented with cardiac arrest. 38 (79.2%) patients had anemia on admission. 21 (43.8%) patients had left ventricular hypertrophy on electrocardiogram while 34 (70.8%) patients had cardiomegaly on chest radiography. The average left ventricular ejection fraction on echocardiogram was 46% and 27 (90%) patients had segmental wall motion abnormalities. The most common angiographic finding was 3-vessel coronary artery disease seen in 50% of patients. Almost all patients received dualantiplatelet therapy, high dose statin, and beta-blocker. The mortality rate was high at 43.8% with cardiovascular causes being the most common cause of death.

CONCLUSION

This study demonstrates the high mortality rate among patients with ESRD presenting with ACS. Our study portrays that patients with ESRD present with higher risk features including abnormalities in vital signs, laboratories, imaging, high prognostications score, and high in-hospital morbidity.

Human ; Kidney Failure, Chronic ; End-stage Renal Disease ; Acute Coronary Syndrome ; Myocardial Infarction

BACKGROUND AND OBJECTIVE

Due to disasters and calamities, the number of internally displaced persons (IDPs) in the country is steadily increasing. With their disadvantaged situation, this population is prone to experiencing powerlessness and poor health outcomes. However, there is limited information on how these communities can gain control over their health and well-being. While community empowerment is a crucial process in the health sciences, this concept remains understudied. Hence, this study aimed to explore the process of community empowerment in health and develop a theory grounded on the experiences of displaced communities.

METHODS

This study utilized the classic grounded theory (CGT), primarily aimed at discovering a conceptual theory anchored on the experiences of internally displaced persons. Particularly, this GT variant sought to explicate a social process of community empowerment in health through the participants’ lenses. A total of 45 individuals from six towns of Bulacan province, Philippines were purposively recruited to participate in focus group discussions and key informant interviews. Data analysis employed the constant comparison method, which involved concept development, reduction, and refinement to derive the emerging theory from the gathered information.

RESULTS

he 5 C's Grounded Theory of Community Empowerment in Health depicts marginalization as the main context of internal displacement, where participants’ experiences of resource deprivation and social neglect made them vulnerable to poor health outcomes. The theory further explicates five processes involved in the empowerment of IDPs, namely: consciousness-raising, collaborating, capacity building, carrying out responsibilities, and continuing work. Particularly, the key steps involve (1) raising the community’s awareness on the importance of gaining control over their health and well-being; (2) establishing collaborative relationships within and outside communities; (3) developing competencies on various health-related domains; (4) assuming multiple roles and implementing programs; and (5) continuing efforts to train more people, sustain partnerships, and expand community involvement. These steps lead to the study’s core variable of self-sufficiency, where communities are anchored on the philosophy of communal unity (bayanihan) in managing their own health needs, promoting healthcare access, and addressing other social determinants of health. Moreover, study findings highlight the unique contribution of women, spirituality, and multisectoral engagement in facilitating the process of community empowerment.

CONCLUSION

This is one of the first few studies to explore the process of community empowerment in health, which guided the development of a theory based on the experiences of internally displaced communities. The theory emphasizes that community empowerment is an iterative and continuous process that involves interactions among community members and other stakeholders. Holistic social preparation and capacity building, together with the integration of local culture and philosophy, could support the successful transition of IDPs into their new lives. Hence, multisectoral collaboration involving government agencies, private offices, higher education institutions, healthcare facilities, and faith-based organizations is crucial in promoting the movement of IDPs from marginalization towards gaining control over their health.

Human ; Grounded Theory ; Vulnerable Populations ; Community Participation

BACKGROUND AND OBJECTIVE

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of hospital and community-acquired infections, showing antimicrobial resistance (AMR), which is an increasing public health concern. One of the commonly-used methods to evaluate resistance include the Kirby-Bauer disk diffusion method. However, this test is found to be time-consuming, lacking in terms of mechanization and automation, alongside its non-applicability to certain antibiotics such as vancomycin. Thus, the Clinical Laboratory Standards Institute (CLSI) recommends using the broth microdilution method in the evaluation of antibacterial activities against S. aureus. A rapid laboratory identification of MRSA is important in the treatment of patients. Therefore, this study aims to optimize and evaluate the effectiveness of a rapid microplate assay using resazurin dye as a colorimetric indicator in determining antibacterial activity against clinical isolates of MRSA and methicillin-susceptible S. aureus (MSSA).

METHODS

Clinical isolates of MRSA and MSSA were obtained from the Philippine General Hospital (PGH) Microbiology Section, and American Type Culture Collection (ATCC) controls of both strains (ATCC 25923 and ATCC 43300) were acquired. These were then subjected to identification and confirmation procedures. A standardization of bacterial inoculum was performed by comparing its 24-hr growth in Mueller Hinton Broth to 0.5 McFarland Standard. The resazurin microplate assay (REMA) was set-up using two-fold serial dilution of control antibiotics such as oxacillin, vancomycin, and cefoxitin. Each plate was inoculated with standardized bacterial growth of controls and clinical isolates. To determine the time needed for the reduction of the resazurin dye, a qualitative assessment was conducted by comparing the reaction time between a 6.75 mg/mL dye with a 0.01 mg/mL dye. The plates were also subjected to different incubation times and dye concentrations, and the optical densities of the plates were compared using a microplate reader.

RESULTS

Results showed that there were no significant differences between the optical densities of the wells of those incubated for 5 hours and for 24 hours (p >0.05). Furthermore, there was a significant reduction in the reaction time of the dye (from 18 hours to 1 hour) when the dye concentration was reduced from 6.75 mg/mL to 0.01 mg/mL. The optimized REMA showed a significant difference between the minimum inhibitory concentrations (MICs) of the different antibiotics against the control and isolate strains of MRSA and MSSA, showing a W of -2.98 (pCONCLUSION

Based on the results presented, the researchers determined the optimal condition for the resazurin microtiter assay, which was 0.01 g/mL concentration of resazurin dye, at a 5-hour incubation period. This study has shown that an optimized REMA is an efficient and fast method to determine the antimicrobial activities of oxacillin, cefoxitin, and vancomycin against MRSA and MSSA.

Methicillin-resistant Staphylococcus Aureus

Background and Objective: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of hospital and community-acquired infections, showing antimicrobial resistance (AMR), which is an increasing public health concern. One of the commonly-used methods to evaluate resistance include the Kirby-Bauer disk diffusion method. However, this test is found to be time-consuming, lacking in terms of mechanization and automation, alongside its non-applicability to certain antibiotics such as vancomycin. Thus, the Clinical Laboratory Standards Institute (CLSI) recommends using the broth microdilution method in the evaluation of antibacterial activities against S. aureus. A rapid laboratory identification of MRSA is important in the treatment of patients. Therefore, this study aims to optimize and evaluate the effectiveness of a rapid microplate assay using resazurin dye as a colorimetric indicator in determining antibacterial activity against clinical isolates of MRSA and methicillin-susceptible S. aureus (MSSA). Methods: Clinical isolates of MRSA and MSSA were obtained from the Philippine General Hospital (PGH) Microbiology Section, and American Type Culture Collection (ATCC) controls of both strains (ATCC 25923 and ATCC 43300) were acquired. These were then subjected to identification and confirmation procedures. A standardization of bacterial inoculum was performed by comparing its 24-hr growth in Mueller Hinton Broth to 0.5 McFarland Standard. The resazurin microplate assay (REMA) was set-up using two-fold serial dilution of control antibiotics such as oxacillin, vancomycin, and cefoxitin. Each plate was inoculated with standardized bacterial growth of controls and clinical isolates. To determine the time needed for the reduction of the resazurin dye, a qualitative assessment was conducted by comparing the reaction time between a 6.75 mg/mL dye with a 0.01 mg/mL dye. The plates were also subjected to different incubation times and dye concentrations, and the optical densities of the plates were compared using a microplate reader. Results: Results showed that there were no significant differences between the optical densities of the wells of those incubated for 5 hours and for 24 hours (p >0.05). Furthermore, there was a significant reduction in the reaction time of the dye (from 18 hours to 1 hour) when the dye concentration was reduced from 6.75 mg/mL to 0.01 mg/mL. The optimized REMA showed a significant difference between the minimum inhibitory concentrations (MICs) of the different antibiotics against the control and isolate strains of MRSA and MSSA, showing a W of -2.98 (p <0.05) using the Wilcoxon Rank-Sum non-parametric test. Furthermore, the REMA has shown better illustration of anti-MRSA and anti-MSSA activities as compared to the Kirby Bauer disk diffusion method. Conclusion Based on the results presented, the researchers determined the optimal condition for the resazurin microtiter assay, which was 0.01 g/mL concentration of resazurin dye, at a 5-hour incubation period. This study has shown that an optimized REMA is an efficient and fast method to determine the antimicrobial activities of oxacillin, cefoxitin, and vancomycin against MRSA and MSSA.
Methicillin Resistant Staphylococcus aureus

BACKGROUND AND OBJECTIVE

Staffing shortages and health inequities are persistent barriers in the Philippines toward achieving universal health care. To ensure an adequate and responsive health workforce, there is a need to evaluate the Human Resources for Health (HRH) status across health facilities, particularly those in underserved communities. Hence, this study aims to determine the staffing requirements and workload pressure among primary care facilities in selected geographically isolated and disadvantaged areas (GIDAs) in the Philippines.

METHODS

The study utilized the workload indicators of staffing need (WISN) methodology from the World Health Organization to determine the staffing and workload situation among three health worker cadres (physicians, nurses, and midwives) in the study sites. Particularly, six primary care facilities (four rural health units and two community hospitals) located in Surigao del Norte were involved in the study. WISN-related data (health service statistics, available working time, and health professionals’ workload components) were collected through records review, focus group discussions, and key informant interviews. The WISN software was used to analyze the staffing levels and workload pressure in the selected facilities.

RESULTS

A total of 40 health workers, including physicians (n = 5, 13%), nurses (n = 21, 52%), and midwives (n = 14, 35%) participated in the study. The findings noted varying levels of staffing and workload pressures among the three cadres in selected primary care facilities, which were influenced by several factors. Particularly, health facilities with additional human resources obtained from deployment programs indicated adequate staffing and low to normal workload pressures. However, further analysis revealed potential HRH maldistribution and reliance on the temporary nature of the staff augmentation program in delivering primary care services, which need to be addressed to optimize health workforce planning. Service workload may also have been impacted by the temporary closure of health facilities due to disasters. Among the few cadres tha reported staffing shortage and high workload pressure, these were due to higher service demands, increased task delegation, and inadequate service coordination. Hence, context-specific challenges and situational factors in GIDAs need to be considered when determining the staffing and workload requirements.

CONCLUSION

There is a need to improve the capacities of health facilities and local government units (LGUs) to engage in evidence-based HRH planning through the WISN methodology. Doing so could improve staffing and workload distribution among health care facilities in the country. Moreover, interorganizational collaboration (DOH, LGUs, and health facilities) should be strengthened to improve delineation and prevent duplication/omission of health services, rationalize HRH distribution and augmentation, and streamline the priority health services based on the local contextual factors.

Primary Health Care

Background: and Purpose High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. Methods: We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis–Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. Results: Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). Conclusions Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.

Background: Medical research is undoubtedly an essential tool in improving health care. Thus, every resident physician should participate in health research activities to keep his knowledge and training up-to-date. Although research is incorporated in residency training, several studies have shown that much is still lacking in terms of the residents’ knowledge, attitude, and practices in research. Objective: To determine the knowledge, attitude, practices, and barriers in conducting research among resident physicians in Cagayan Valley Medical Center. Methods: This study utilized a descriptive survey design. Purposive sampling with total enumeration was done. A total of 108 resident trainees were included in the study. Validated questionnaires were used to assess the residents’ knowledge, attitude, practices, and barriers in conducting research. Results: The level of research knowledge of the resident trainees is below average, and their overall research practice is poor. On the contrary, the residents’ attitude towards research is positive. The residents’ level of research knowledge significantly differed across age (p=0.010) and year level (p=0.012). The trainees’ research attitude significantly differed in terms of current involvement in research (p=0.048). The top three barriers identified were lack of research training and skills, insufficient time allotted for research, and lack of statistical support. Conclusion There is a need to fill the gap between the residents’ positive attitude and their below average level of knowledge and poor practice in research. Addressing the barriers in conducting research is also needed to improve the overall standards of research among the residents.
Attitude ; Health Knowledge, Attitudes, Practice ; Knowledge

Background: COVID-19 caused educational institutions to transition online, necessitating tailored interventions in spreading factual information. Formal learning in the Philippines has yet to resume physically. Objectives: This methodological and formative research sought to develop a contextualized, home-based, and age-appropriate COVID-19 prevention curriculum for Filipinos within ages 5-8, 9-12, and 13-16. This articledescribes the process of co-developing the curriculum and identifying key themes in curriculum development which may be relevant to low-middle income countries (LMIC). Methodology: Preliminary curriculum materials were developed based on COVID-19 prevention literature and existing health promotion materials. A focus group discussion (FGD) with eight subject experts was conducted to explore the barriers and facilitators to knowledge and behavioral change. Results were analyzed thematically using predetermined themes: content, structure, delivery, and appropriateness to context. Results: The co-development provided insights through academic, professional, and cultural lenses. Subthemes were generated from content, delivery, structure, and appropriateness to context recommending the use of activities that are engaging and empowering to the child and providing support for carers. Curriculum key outcomes of this research include a clearer, comprehensive, accurate, and contextualized curriculum in relation to the target age groups. Conclusion Curriculum co-development may be improved by involving key persons in the community. To promote behavioral change and hygienic practices among Filipino children, active, constructive, and interactive learning methods, as well as a motivational approach, must be employed. Major findings for curriculum effectiveness highlighted the importance of the following: prevention-focused materials, accurate and updated information, summary provisions at the curriculum's end, availability of activity materials, household involvement, and open-ended activities. Future research may work on contextualizing other health literacy curricula to the local context and tailoring interventions at the community level.
COVID-19 ; Curriculum ; Hygiene ; Child

OBJECTIVE: To correlate male lower urinary tract symptoms between age, quality of life scores,parameters of uroflowmetry and prostate size. PATIENTS AND METHODS: Two hundred eight males were included in this study. Uroflowmetry parameters,age, International Prostate Symptom Score (IPSS), Quality of Life (QoL) scores and prostate sizewere gathered. For correlation, distribution of age, uroflowmetry parameters and prostate size werefirst compared to IPSS. Analysis of variance was used to compare age of patients, while Kruskall-wallis test was used to compare the QoL, uroflowmetry parameters, and prostate size on each IPSSgroups. Ordinal logistic regression analysis was used to correlate IPSS to age, quality of life,uroflowmetry parameters, and prostate size both for multivariate and univariate analysis. RESULTS: There was no significant correlation between age and IPSS. However, on profile distribution,the age distribution between symptom scores were statistically similar. Qol scores were directlyproportional to IPSS. Thus, patients with a worse QoL score were more likely to have higher IPSS.Qmax scores decreased as symptom severity increased. Patients with higher Qmax scores are lesslikely to have higher IPSS scores. Voided volume was observed to decrease as IPSS severity increased,but this was not statistically significant. Patients with higher post void residual scores were morelikely to have higher IPSS. There was also no significant correlation between prostate size and IPSS. CONCLUSION There were no significant correlation between IPSS and age, voided volume and prostatesize. On the other hand, patients with a worse QoL score and a high post void residual had higherIPSS. Patients with a high Qmax, are less likely to have an elevated IPSS.

OBJECTIVE: To report on the implementation and initial pilot data of diabetic retinopathy (DR) identified using a validated telemedicine program for DR in a multispecialty primary care clinic.
METHODS: This was a retrospective, cross-sectional pilot survey of diabetic patients imaged for the first time at the telemedicine program of The Medical City from November 26, 2012 to August 31, 2013. The retinal images were obtained following the validated program of the Joslin Vision Network nonmydria. tic fundus photography for DR evaluation. These were evaluated by 4 retina specialists using a standardized protocol to assess for diabetic retinal disease and the presence of other retinal findings. The findings were recorded on customized electronic templates.
RESULTS: Seven hundred seventy-six (776) eyes of 388 patients were evaluated using the telemedicine program. The prevalence of DR was 28.2% (219 eyes), with 25.1% (195 eyes) having nonproliferative DR (NPDR). 14.2% 1110 eyes] had mild, 8.2% [64 eyes] moderate, 2.2% [17 eyes] severe, and 0.5% [4 eyes] very severe NPDR. 3.1% (24 eyes) had proliferative DR (PDR), of which 45.8% (11 eyes) had high-risk characteristics. The ungradable rate with selective mydriasis was 1.80% (14 eyes). The rate of referable DR (moderate NPDR or worse, any level of diabetic macular edema, or ungradable images) was 21.90% (170 eyes).
CONCLUSION: In the primary care setting, teleophthalmology can effectively identify patients with diabetic retinal complications and potentially refer these patients to appropriate levels of eye care. Retinopathy was present in over 28% of patients evaluated and over 21% had referable disease that may potentially progress to vision loss. Teleophthalmology for DR in this setting allows early detection of potentially sight threatening disease and may prevent visual loss and complications.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Diabetic Retinopathy ; Macular Edema ; Mydriasis ; Retina ; Retinal Diseases ; Telemedicine ; Primary Health Care